Plasticizer types affect quality and shelf life of eggs coated with rice protein

The aim of study was evaluate the effect of using rice protein coating with different plasticizers types on the quality of eggs storaged at 20 °C for 6 weeks. Three hundred eggs were coated with rice protein at 8% solution combined with glycerol, propylene glycol or sorbitol. Uncoated eggs showed the highest weight loss (5.31%), while rice protein with glycerol (4.29%) propylene glycol (4.13%) and sorbitol (4.07%) solutions were effective in preventing weight lost. Uncoated eggs had the worst HU (58.40), albumen (9.52) and yolk (7.06) pH, and YI (0.33) after 6 weeks of storage. The eggs coated of rice protein with glycerol, propylene glycol and sorbitol presented results with similar intern quality between them during all the storage period. However, the use of sorbitol as a plasticizer in the coating is more efficient in maintaining control of the increase in albumen pH. Scanning electron microscopy demonstrated a lower surface porosity in coated eggshell, indicating that the use of the coating may provide a protective barrier against the transfer of gases and moisture. In conclusion, the best egg protection results in terms of egg quality are obtained in eggs coated with rice protein and sorbitol.

INFLUÊNCIA DOS TUTORES NO HÁBITO INGESTIVO DE CÃES

O objetivo deste estudo foi avaliar através de um questionário se os tutores podem influenciar o hábito ingestivo de seus cães e ao favorecimento do consumo de outros alimentos além do alimento completo e balanceado. O questionário continha 28 perguntas do tipo misto com perguntas abertas e fechadas, foi difundido através das redes sociais no período de janeiro de 2018 a abril de 2018, e obteve-se 397 respostas. Através dos resultados foi possível concluir que a rotina dos tutores influencia o hábito ingestivo dos cães, e que os tutores dividem o alimento humano com os cães e influenciam na forma de alimentação desses animais.

The frequency and cost of patient-initiated device removal in the ICU

OBJECTIVE

To determine the frequency and pattern with which patients in the intensive care unit (ICU) remove medical devices on their own, and the costs associated with this problem.

DESIGN

Prospective observational study.

SETTING

Two 10-bed sections of a multidisciplinary ICU in a tertiary care teaching hospital.

PATIENTS

Adults admitted to the ICU for longer than 24 hours during October 1998.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Medical records were reviewed prospectively for the occurrence of patient-initiated device removal and the responses to those events by health care providers. Associated costs were estimated using hospital databases and Medicare physician reimbursement schedules. Annual cost estimates were calculated using 1997 admission statistics for 1211 adults in an ICU for more than 24 hours. Thirty-six patients were studied for 199 patient-days. Ten patients (28%) removed 42 devices: 88% of these events involved gastrointestinal tubes and vascular catheters. Significant agitation was documented within 2 hours before 74% of the events. Estimated cost associated with device removal was $7606, or $181/event. The estimated annual cost in this 42-bed ICU was more than $250,000.

CONCLUSIONS

Patients commonly remove medical devices on their own, and this represents significant consumption of health care resources.

Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU

STUDY OBJECTIVE

To study the frequency, duration, severity, and treatment of agitation in patients in the intensive care unit (ICU) to determine if the elderly represent a distinct population.

DESIGN

Prospective cohort study

SETTING

Tertiary care, 10-bed, multidisciplinary ICU.

PATIENTS

All patients older than 18 years of age admitted for longer than 24 hours during a 4-month period.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

One hundred thirty patients were studied for 916 patient-days; 63 (48%) were elderly (> 65 yrs). Nurses and physicians described agitated behavior in 92 patients (70.8%) during 534 (58.3%) patient-days, and it was severe or dangerous in 60 patients (46.1%) during 273 (30%) patient-days. There were no age-related differences in frequency, severity, and duration of agitation. Opiates, benzodiazepines, and haloperidol were administered during 72%, 62%, and 29% of agitated patient-days, respectively. Haloperidol was administered more often to elderly patients (p=0.015); otherwise no between-group differences were noted. Daily dosing requirements were less in the elderly for intermittent intravenous lorazepam, haloperidol, and morphine but not for midazolam (p=0.15). When these dosages were corrected for body mass, no statistical differences between young and old were found.

CONCLUSION

In the ICU, the elderly are not a distinct population for agitation.

Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale

OBJECTIVE

To describe the level of sedation for a cohort of mechanically ventilated adult intensive care unit (ICU) patients using validated subjective and objective tools.

DESIGN

Prospective convenience sample.

SETTING

Multidisciplinary 34-bed ICU at Maine Medical Center, a 599-bed nonuniversity, academic medical center.

PATIENTS

Sixty-three adult ICU patients were monitored during 64 episodes of ventilatory support.

MEASUREMENTS AND MAIN RESULTS

Patients were prospectively evaluated by one trained investigator using the revised Sedation-Agitation Scale (SAS) and were simultaneously monitored for 1 to 5 hrs using the Bispectral Index (BIS), a numeric scale from 0 to 100 derived from the electroencephalogram. BIS values were assigned to baseline, stimulated, and average conditions for each patient by a separate investigator blinded to SAS scores. Ventilator settings, medications, and the lung injury severity (LIS) score were also recorded. Sedation levels varied from very deep sedation (SAS score = 1, BIS score = 43) to mild agitation (SAS score = 5, BIS score = 100). Heavily sedated patients (SAS score = 1-2, n = 20) had higher FIO2 (0.52 vs. 0.42, p = .008), oxygenation index (9.4 vs. 5.4, p = .03), and LIS scores (1.3 vs. 0.7, p = .004) and lower baseline (66 vs. 78, p = .01), average (66 vs. 81, p < .001), and stimulated (89 vs. 96, p = .016) BIS scores compared with more awake patients. Patients with intermittent neuromuscular blockade use (n = 4) had higher FIO2 (0.65 vs. 0.44, p = .006), minute ventilation (14.6 vs. 9.9 L/min, p = .005), positive end-expiratory pressure (7.5 vs. 4.8 cm H2O, p = .05), oxygenation index (15.7 vs. 6.0, p < .001), and LIS scores (3.3 vs. 1.0, p = .036) and were more sedated, with higher suppression ratios (3.5 vs. 0.6, p = .05) and lower SAS scores (1.5 vs. 4, p = .035). The average BIS values correlated well with SAS (r2 = .21, p < .001).

CONCLUSIONS

SAS and BIS work well to describe the depth of sedation for ventilated ICU patients. Deeper sedation and intermittent neuromuscular blockade were used for patients with greater ventilatory requirements and more severe lung disease. The correlation between subjective and objective scales varied in medical, surgical, and trauma patients. Further research with SAS and BIS may facilitate the development of quantitative sedation guidelines for the ICU.

Antibiotic optimization. An evaluation of patient safety and economic outcomes

BACKGROUND

Although numerous reports have described interventions designed to influence antibiotic utilization, to our knowledge none have been evaluated in a randomized study.

METHODS

Adult inpatients receiving 1 or more of 10 designated parenteral antibiotics for 3 or more days during a 3-month period were randomized to an intervention (n = 141) and a control (n = 111) group using an unblocked, computer-generated random number table. Obstetric patients and those seen in infectious disease consultation were excluded. The intervention group received antibiotic-related suggestions from a team consisting of an infectious disease fellow and a clinical pharmacist. Both groups were evaluated for clinical and microbiological outcomes as well as antibiotic utilization via prospective chart reviews and analysis of the hospital's administrative database.

RESULTS

Sixty-two (49%) of the intervention group patients received a total of 74 suggestions. Sixty-three (84%) of these suggestions were implemented; the majority involved changes in antibiotic choice, dosing regimen, or route of administration. Per patient antibiotic charges were nearly $400 less in the intervention group vs controls (P = .05). Almost all the savings were related to lower intravenous antibiotic charges. Clinical and microbiological response, antibiotic-associated toxic effects, in-hospital mortality, and readmission rates were similar for both groups. Multiple linear regression analysis identified randomization to the intervention group and female sex as the sole predictors of lower antibiotic charges. There was a trend toward a shorter length of stay for the intervention group (20 vs 24.7 days, P = .11).

CONCLUSIONS

This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashion without sacrificing patient safety. We demonstrate that 50% of patients initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifications result in good clinical outcomes with a substantial reduction in antibiotic expense.